Credentialing Specialist

Company Description

PangeaEmr is a USA based comprehensive solution provider for private medical practices, offering a wide range of services through a single dashboard.

Our services include credentialing, medical billing, revenue cycle management, payment platforms, SEO-optimized websites, review systems, insurance verification, prior authorization, remote patient monitoring, and electronic health records (EHR). We are unique in the healthcare industry for providing an all-in-one approach to help doctors be more productive. Supported by our visionary investors, we aim to create a more efficient, profitable, and patient-centric healthcare system.

Role Description

This is a full-time remote role for a Credentialing Specialist. The Credentialing Specialist will be responsible for handling the credentialing process for medical staff, ensuring all necessary documents are collected, verified and maintained. They will work closely with healthcare providers and insurance companies, conduct regular follow-ups, and provide exceptional customer service to address any inquiries or issues related to credentialing. They will also manage medical staff credentialing for Medicare and other insurance providers.

This role will involve overseeing the lifecycle of provider credentialing, ensuring compliance with regulatory requirements and internal policies.

Candidate will be hired in our Indian subsidiary. Payroll will happen through Indian company.

Qualifications

• Experience in Doctor Credentialing and Medical Staff Credentialing
• Manage the end-to-end credentialing process for healthcare providers, including initial credentialing, recredentialing, and privileging.
• Review and assess provider applications for completeness, accuracy, and adherence to regulatory standards.
• Conduct primary source verifications of provider credentials, including licensure, education, training, certifications, and professional references.
• Collaborate with providers, and internal stakeholders to obtain necessary information and resolve any credentialing-related issues or discrepancies.
• Ensure compliance with regulatory requirements, accreditation standards, and credentialing policies and procedures.
• Maintain comprehensive and up-to-date provider credentialing files, ensuring confidentiality, accuracy, and data integrity.
• Monitor and track provider expirable, such as licenses, certifications, and malpractice insurance, to ensure timely renewals.
• Participate in audits and internal quality assurance activities to identify opportunities for process improvement and enhance credentialing practices.
• Stay abreast of industry trends, changes in credentialing regulations, and best practices, providing recommendations for improvement and adaptation.
• Assist in the development and implementation of credentialing policies, procedures, and training programs.
• Provide guidance and support to junior credentialing staff members, fostering a collaborative and high-performing team environment.
• Strong Communication and Customer Service skills
• Familiarity with Medicare and other insurance providers
• Excellent organizational and time management skills
• Ability to work independently and remotely
• Strong attention to detail and problem-solving abilities